<div class="pageContent">
	<form method="post" action="admin/clearing/collect/collectFreeze" class="pageForm required-validate" onsubmit="return validateCallback(this, dialogAjaxDone);">
		<div class="pageFormContent" layoutH="56">
			<p>
				<label>渠道编号：</label>
				<select name="channelCode">
					<option value="">请选择渠道</option>
               		#for(channel : channelList)
               			<option value="#(channel.code )" #(channel.code == channelCode ? 'selected' : '' )>#(channel.name )</option>
               		#end
				</select>
			</p>
			<p>
				<label>机构编号：</label>
				<input name="orgCode" type="text" size="30" class="required" />
			</p>
			<p>
				<label>商户编号：</label>
				<input name="merchCode" type="text" size="30" class="required" />
			</p>
			<p>
				<label>冻结金额：</label>
				<input name="freezeAmount" type="text" size="30" class="number" />
			</p>
		</div>
		<div class="formBar">
			<ul>
				<li><div class="buttonActive"><div class="buttonContent"><button type="submit">保存</button></div></div></li>
				<li>
					<div class="button"><div class="buttonContent"><button type="button" class="close">取消</button></div></div>
				</li>
			</ul>
		</div>
	</form>
</div>
